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Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS) Trial

经济学应用

基本信息

批准号：
10007047
负责人：
JASON N. DOCTOR
金额：
$ 72.6万
依托单位：
UNIVERSITY OF SOUTHERN CALIFORNIA
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-15 至 2022-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10007047
关键词：
Accident and Emergency department Adherence Adult Adverse event Affect American Behavior Behavioral Benzodiazepines Binding CCL4 gene California Caring Centers for Disease Control and Prevention (U.S.)Cessation of life Clinic Clinical Cluster randomized trial Country Data Dose Dose-Rate Economics Education Electronic Health Record Event Exposure to Future Goals Guideline Adherence Guidelines Health system Illinois Intervention Knowledge Life Motivation Opioid Oregon Overdose Pain Pain management Patients Performance Persons Pharmaceutical Preparations Pharmacotherapy Phase Poisoning Population Prevention Guidelines Primary Health Care Psyche structure Psychology Recommendation Reporting Safety Social Psychology Suggestion Techniques Testing Text Therapeutic Treatment outcome Urine Visit Work base behavioral economics chronic pain design drug testing expectation improved insight morphine equivalent non-cancer pain non-opioid analgesic novel opioid exposure opioid misuse opioid overdose opioid policy opioid use opioid use disorder peer prescription opioid prevent primary outcome response secondary outcome social tool trial comparing uptake

项目摘要

ABSTRACT There is a lack of evidence that long-term opioid use offers benefit for noncancer pain and an abundance of evidence of harm. Last year, the Centers for Disease Control and Prevention (CDC) issued the “CDC Guideline for Prescribing Opioids for Chronic Pain” to encourage safe and effective alternatives to opioids, discontinuation of opioids when patients do not resume normal activities and prudent dosing strategies. However, poor guideline adherence is a general concern and may impede uptake. Our prior studies have used insights from behavioral economics and social psychology to increase guideline adherence. We propose to apply these techniques within the Application of Economics & Social psychology to improve Opioid Prescribing Safety (AESOPS) Trial to improve adherence to the CDC and to the Oregon Pain Guidance pain management guideline. In the R21 phase, we will assess the feasibility of implementing the following candidate nudges: 1) Defaults (guideline concordant actions that take place when clinicians fail to act), 2) precommitments (advanced commitments by clinicians to guideline adherent behaviors that bind them to these behaviors in the future), 3) justifications (free-text responses entered by the clinician that explain why guidelines were not followed and which are recorded as a patient note in the electronic health record); these are triggered when defaults are removed and commitments are not honored, 4) peer comparisons (a type of socially motivated performance reporting) and 5) a nudge to increase the salience and availability of adverse opioid events. In the R33 phase, we will conduct the AESOPS trial, an 18-month cluster randomized trial. The trial is across 374 primary care clinics in the U.S. We compare three conditions: C1) Peer comparison and justification , C2) defaults, precommitments or available adverse events added to the C1 interventions, C3) education control. The primary outcomes is clinician aggregate monthly mg morphine equivalent (ME) for patients with >50 mg ME daily dose. Secondary, outcomes are benzodiazepine co-prescribing and rate of dose escalation to >50 mg ME/day. We anticipate that the AESOPS trial will provide new knowledge about how to improve adherence to the CDC Guideline for Prescribing Opioids for Chronic Pain and to concordant pain guidelines. The trial may also help us understand how to prevent future incidents of opioid use disorder and opioid poisoning death by lowering unnecessary population exposure to these drugs.

摘要